Case presentation
An 85-year-old man with dysphagia was admitted to our hospital. Computed tomography (CT) revealed prolapse of a massive hiatal hernia involving the stomach (Fig.1a) and pancreatic body (Fig.1b). His CT findings also showed an 8-mm enhanced solid component in the cyst, which was found in the pancreas body (Fig.1c). We suspected that an intraductal papillary mucinous neoplasm was the most likely diagnosis, and surgery was indicated. We performed hiatal hernia repair, followed by laparoscopic distal pancreatectomy. Ports were placed in the umbilical region, bilateral hypochondria, and bilateral upper abdomen. A large hiatal hernia was also observed. A large part of the stomach had prolapsed into the mediastinum (Fig2a). The adhesion between the hernia sac and the omentum was peeled off. The hernia orifice was sutured with a non-absorbable thread while pulling the esophagogastric junction (Fig2b). Fundoplication was performed from the front, and hiatal hernia repair was completed. Distal pancreatomy was then performed using five ports. The pancreas then returned to its normal position. Tunneling of the pancreatic parenchyma was performed immediately above the portal vein. The pancreatic parenchyma was dissected using a laparoscopic linear stapler (Fig2c). Splenic arteries and veins were dissected. The pancreatic tail and spleen were detached from the retroperitoneum, and the specimen was removed. In this case, gastric stasis occurred but improved conservatively. Esophageal reflux was not observed, and the patient was transferred to another hospital on postoperative day 13.